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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address:Granite Alliance Insurance Company P.O. Box 1382 Maryland Heights, MO 63043Fax Number:

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How to fill out gaic coverage determination request

01

Step 1: Gather all necessary information and documents related to the patient's medical condition and treatment.

02

Step 2: Visit the official website of GAIC (Genworth Advanced Illness Care) or contact their customer service for the coverage determination request form.

03

Step 3: Fill out the coverage determination request form accurately and provide all required details, including patient information, diagnosis, prescribed treatments, and any supporting medical records.

04

Step 4: Attach any additional documentation or medical evidence that supports the need for coverage determination.

05

Step 5: Double-check the completed form and attached documents for accuracy and completeness.

06

Step 6: Submit the filled-out coverage determination request form and all supporting documents to GAIC either by mail, fax, or through their online submission portal.

07

Step 7: Keep a copy of the submitted request form and documents for your records.

08

Step 8: Wait for a response from GAIC regarding the coverage determination. They will review the request and make a decision based on the provided information.

Who needs gaic coverage determination request?

01

Individuals who have Genworth Advanced Illness Care (GAIC) insurance coverage and require clarification or confirmation on the coverage for a specific medical condition or treatment.

02

Healthcare providers and medical professionals who are managing patients with GAIC coverage and need to request coverage determination.

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What is gaic coverage determination request?

The gaic coverage determination request is a form submitted to the insurer to determine coverage for a specific claim or service.

Who is required to file gaic coverage determination request?

Healthcare providers or patients may be required to file a gaic coverage determination request.

How to fill out gaic coverage determination request?

To fill out a gaic coverage determination request, provide all relevant information about the claim or service in question.

What is the purpose of gaic coverage determination request?

The purpose of a gaic coverage determination request is to clarify if a specific claim or service is covered by the insurance policy.

What information must be reported on gaic coverage determination request?

Information such as patient details, service provided, diagnosis, and medical necessity must be reported on a gaic coverage determination request.

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